As a 52-year-old mother, author Tracey Jackson looks back on her youth and the contradictory messages of our culture to get a handle on the mythology of aging in “Between a Rock and a Hot Place: Why Fifty is Not the New Thirty.” Here’s an excerpt.
If I'm thirty, why do I need a colonoscopy?
When I was thirty I had four doctors in my address book: a gynecologist, a dentist, a GP, and a vet. At fifty-two I have thirty-five. I have the above-mentioned group, though I now have two gynecologists, one on each coast (I work in LA a lot); I also have a cardiologist, an endocrinologist, a gastroenterologist, three dermatologists (one regular dermatologist for vanity-related issues, one who specializes in lasers for a skin disease my husband came down with at fifty, and one to do the annual mole check). I have a dentist for us and one for the kids, an orthodontist, and an oral surgeon for the odd root canal. I have a radiologist for mammograms, a rheumatologist, a plastic surgeon, a pediatrician for my youngest and an adolescent specialist for my oldest, a pediatric gastroenterologist — oh, and a pulmonary specialist for my older daughter’s and my asthma. There are two ear, nose, and throat doctors, one who specializes in acid reflux and one for the basic blocked sinuses. There are two orthopedists, one for the kids and one for us. I have a psychopharmacologist and an ophthalmologist, plus in the last nine months we have added a electrophysiologist and a radiologist who specializes in cardiac imaging. My French bulldog has an orthopedist as well as a neurologist. (In dog years he is not yet fifty, so we chalk it up to bad genes.)
My husband informed me the other day that the endocrinologist says we need an urologist. I said, “Why?” He said, “Over fifty, everyone needs one.” So we will add him to the list as well. We also have a couple of shrinks, a nutritionist, and an acupuncturist. I don’t want to make us sound totally loony or in dire medical shape; we don’t use all these people on a regular basis, but they have all entered our lives and my address book at one time or another.
I already had to kick several people off the E page of my address book to make room for all the doctors spilling off the D page. The odd thing is that even though I have a lot of “ologists” in my life, I feel pretty good — or perhaps I feel good because of them all. Do I feel the same as I did at thirty? In some ways better; actually; if you remove the menopause, I feel almost the same. I do suffer from acid reflux, which used to just be indigestion. Now, of course, something historically thought of as benign if left untreated can cause hideous damage later on. And quite honestly, I’m not sure what fifty is supposed to feel like.
I guess the question is, if we are feeling well, why do we have so many doctors? It seems like every doctor you go to feels he or she needs to send you to someone who knows more about a particular thing. Didn’t Marcus Welby take care of everything? And if he couldn’t, James Brolin cruised in on his motorbike and picked up the slack.
What I do know is that come fifty, we are supposed to get tested on a regular basis for a multitude of possible health disasters. This indicates we have arrived at the place where — well, sh-- happens. My friends run the gamut, from amazing health to so-so health, chronic problems, cancer in the past, cancer in the present, and, on the far end, dead. Every day you hear of someone new who has been diagnosed with something dreadful. You say a prayer for them and one for yourself and your loved ones, and then you live your life. What else can you really do?
For whatever reason, fifty is this magical number when it comes to health. The age range between fifty and sixty-five is sometimes referred to as to as the Bermuda Triangle of health. It’s pretty evident what that means: it’s a big dark hole that out of nowhere just sucks you into its vortex. Apparently if you avoid the triangle altogether, you can trundle on into your eighties. While part of me buys into the theory that these fifteen years are without question the age where good health can no longer be taken for granted, if you make it to sixty-five okay, the getting to eighty does not always follow; I know plenty of people who succumb in their seventies. I suppose it’s just a flashing sign that says Danger Ahead. In the animal world it’s referred to as culling: the less likely to survive of the species are taken out so the strong can survive and make the herd that much tougher. There is a Darwinian aspect to it all as well.
For those who are trying to keep a positive attitude and even pretend they are actually getting younger, it’s not easy given the daily reminders we get from those who are actually sick, the people who know someone who has been diagnosed with something deadly, those who know someone who knows someone who’s sick, and on and on.
Once I told one of my many doctors a story about a friend of mine who was dying of cancer at the age of forty-six. His response was, “We all have friends and some of our friends aren’t doing so great. That’s the way it goes.” I guess you cannot be a doctor if you don’t accept that sh-- happens. That doctor is no longer on my list.
And if you are fifty, there is no escaping it. My daughter’s fourth-grade health form asked, “Has anyone in the family had cancer, heart disease, or a serious illness?” — not sure what category they put the other two in — “or sudden death before fifty?” What they are not so subtly saying is that if you come down with any of these things before fifty it’s abnormal, but after fifty it’s to be expected. And then of course every other commercial on TV is about someone with some ailment, and because the actors they have hired to play them are all in their late forties or early fifties, they look just like you. From prime time sports to morning talk shows, pharmaceutical ads seem to be outnumbering all others. One day on "Good Morning America" I counted four in the one hour I watched — one distressing reminder every fifteen minutes of what your future could hold. Not a great way to start the day.
I watched TV incessantly throughout my childhood and adolescence. I have been watching TODAY and GMA my entire life, and I can’t remember a time when there were ads for so many prescription medications, especially those with dastardly side effects. I remember “Charlie says, ‘Love my Good & Plenty,’ ” not “All around the world, men with ED have taken thirty-six-hour Cialis.”
Then there was “Two times the flavor, two times the fun, Doublemint, Doublemint, Doublemint gum.” A hell of lot catchier and more uplifting than “Another heart attack could be lurking.”
How about “Does she or doesn’t she?” for Clairol hair color, as opposed to “Depression hurts” for Cymbalta?
And what would you rather see, a big funny-looking green guy bellowing “From the valley of the jolly (yo, ho, ho) Green Giant,” or a fifty-seven-year-old heart attack survivor earnestly confessing, “My doctor told me I should be doing more for my high cholesterol. What was I thinking? Now I trust my heart to Lipitor.”
And my all-time favorite: “Say hello, say hello to Poppin’ Fresh dough,” a happy, cheery commercial that made you want to immediately go out and buy a roll of ready-to-bake biscuits instead of running out and getting a full body scan. I’m sure today they would have the Pillsbury Doughboy on Plavix, for heart disease, and they would tell you that the side effects are severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, and swelling of the mouth, face, lips, or tongue), bleeding in the eye, change in vision, change in the amount of urine, chest pain, dark or bloody urine, black tarry stools, unusual or severe bleeding (e.g., excessive bleeding from cuts, unexplained increased vaginal bleeding, unusual bleeding from the gums when brushing), loss of appetite, pale skin, seizures, severe or persistent headache, sore throat or fever, speech problems, unusual bruising, weakness, unexplained weight loss, and yellowing of the skin or eyes.
Personally I prefer “A perfect crescent roll every time.”
Now, I know the crescent roll could give you diabetes, and the fat content is high and that could raise your cholesterol, but talk about not growing old gracefully — this is growing old more fearfully than we have to. I’m all for prevention and intervention, but do I have to be reminded of it 24/7?
The only medical commercial I recall from my childhood is “Excedrin Headache 110.” There is a reason for this: drug companies were not allowed to advertise prescription medication on TV until 1995, which was oh so conveniently around the time the oldest boomers were forty-nine — a year away from fifty and the onset of chronic diseases. America’s largest generation and biggest spenders were likely to be buying more meds than Niblets corn and candy.
The fact that the perpetually peppy Sally Field, who will always be the Flying Nun and Gidget to me, is suffering from bone loss and taking Boniva to counteract it makes me so despondent I could — well, use a good dose of Abilify, one of the other widely advertised drugs that combats depression. But this is where they are so clever: despite her age, who is more eternally young than Sally Field? If it could happen to her, it could certainly happen to us, so we’d better get that bone density test and start the Boniva before you can say “double hip replacement” instead of “Doublemint gum.”
But we should look on the bright side. Just because Sally’s bones are crumbling doesn’t mean everyone’s will; maybe hers took a real beating with all that flying and getting knocked around by the surfboards. Maybe Moondoggie had a thirty-six-hour erection and banged the hell out of her and that caused her bones to become brittle. But actually that couldn’t have happened since they didn’t have Cialis or Viagra back then, and Moondoggie was young, so erectile dysfunction was probably not an issue (though premature ejaculation might have been, but they won’t bother bombarding us with ads for that because it’s not a big problem for those over fifty).
I make jokes because that is my way, but the truth is we find ourselves again at yet another odd place: on the one hand, we are told fifty is the new thirty, but if you watch the relentless ads on TV we are told we either are depressed, suffer from heart disease, have bone loss, have to deal with erectile dysfunction, or must cope with a leaky and overactive bladder, and if we don’t now, we will soon. The people in those spots don’t look a day over fifty-two, but they are darting to the bathroom so they don’t wet themselves. Pass the Paxil, another widely advertised antidepressant; I may be needing those Depends soon.
The really scary thing is the drug companies are now spending twice as much on advertising as they are on research. Considering that one out of every five Americans will be age fifty to sixty-five — smack dab in the waters of the Bermuda Triangle — by 2015, I think their money would be better spent on helping us rather than hustling us. The medical stats for this set are not great — seven out of every ten Americans in this age group have at least one if not several chronic health conditions. Those conditions range from heart disease and diabetes to chronic back and stomach problems. So if you are fifty, chances are something is bothering you some of the time.
If you happen to be one of the lucky ones who aren’t plagued by multiple illnesses, you end up spending an inordinate amount of time worrying about them — although you may not be worrying about the right things. Though all the data tell us women have a far greater chance of dying of a heart attack, almost every woman I know is convinced that it is breast cancer that will ultimately do her in. I don’t know any women who are remotely concerned about heart attacks, or strokes for that matter. And while heart attacks kill many more of us than any cancer including that of the breast, and we are far more likely to get whacked by a stroke than our male counterparts, we seldom ponder these ailments as part of our future. We never worry about broken hips, which are far riskier and more prevalent for women than ovarian, uterine, and breast cancer combined. Thirty-three percent of boomer women will break a hip. And seven out of every one hundred of those women will die within a year of that injury. That’s a big number — it’s higher than the percentage of women who will die from breast cancer. But we don’t think or talk much about those ailments, much less walk for them or buy lipsticks that provide proceeds to them; we pretty much focus all our medical paranoia and attention on breast cancer.
In our defense, you cannot find a woman at fifty who doesn’t have at least one relative or friend who has had breast cancer. Many of us have lost people we love to it. Right now, without digging very deeply, I can come up with twenty-five women I know personally who have either survived it, are battling it, or have succumbed to it. And if I play the one-step-removed game I could probably reach sixty. I have yet to lose any woman I know to a heart attack, much less a hip fracture; that will come in time, but fifty is usually still too young for that. I know of no other disease that has afflicted as many women my age as breast cancer, and I’m sure that that means every other fifty-year-old woman can say the same thing.
While it is true more women will be diagnosed with it than with any other cancer, most women will not. Twelve percent will suffer breast cancer in their lifetimes. That is far from everyone. Yet it doesn’t feel that way. It feels like everyone has it or gets it and that we could very well be next in line.
Ask any basically healthy woman the worst day in the year, and (excluding the anniversary of a loved one’s death) nine times out of ten she will say, “Mammogram day.” I start worrying about it a good three months before the actual appointment.
Sometimes I play a game and shift the appointment around — if I have a big event I want to be in a good mood for, I will put it off, thinking, God forbid they should find something, I don’t want it to ruin my week. I never have them around the holidays, as I have always felt that would be the ultimate bummer — you get the news in November and destroy everyone’s Christmas. Spring doesn’t work; I used to get them in the spring, but my birthday and the birthday of one of my daughters are in May, and I would hate to put a damper on those occasions. And then the fall — well, there’s way too much going on then, what with back-to-school, my husband’s birthday, and usually the beginning of a new project. I kept moving my yearly appointment around until I got the right time, June or July. We don’t tend to travel that time of year, so if something goes awry I have the summer to deal with it.
So it’s June or July and I make appointments only for the eighth, or the sixteenth if they don’t have the eighth. I do this because eight is my lucky number. If the eighth is a weekend, I book the sixteenth, eight plus eight — double eight means double your chances, double your luck, good mammogram day? I hope.
All women of a certain age understand the mammogram terror. There is a look we give each other; it’s our secret-society-of-fear look. We whisper under our breath, “Tomorrow is mammogram day.”
Then the person you’ve told gives you that sympathetic look and says, “Oh sh--, really? I had mine a month ago. Thank God it was okay. You want me to go with you?”
There is no other routine doctor’s appointment or test that people volunteer to accompany you on as often as a mammogram.
“Tomorrow I’m getting my moles checked.”
“Really? Want me to come?”
And no one offers to go with you to get a colonoscopy.
But because we all suffer from this collective fear of breast cancer, it’s just a given that a good friend or even a not-so-good friend will go with you if you want. And a not-so-good friend instantly turns into a great friend if she makes the offer.
I never want anyone to go with me. My husband offers, and I shoot him down immediately. “If you go, then it looks like I have cancer and we’re worried.” If I ever see a husband in the waiting room of my radiologist, I know the woman has gone through it and is in there for a follow-up appointment or is about to get bad news.
If you take a friend, it’s not as bad as taking a spouse, but it still looks like you’re really afraid or you expect to need her. I don’t want to look like that, nor do I expect to need anybody, though deep down I always fear I will.
For me it’s important to march in there despite the fact I’m a nervous wreck and pretend to be strong and fearless. If I act as if nothing is wrong, I figure, nothing will be.
And the entire way there I am making deals with God. “If you make this mammogram clean, I promise to devote more time to charity work. I will not get impatient with stupid people. I will do anything you want. Just give me the word — no lumps in my breasts and I’m at your service.” So you galvanize your internal army of strength, you have a heart-to-heart with whatever force you believe in, and then you walk into the office, and all the women there waiting their turn look like dead women sitting, even though three-quarters of them haven’t even been seen yet. Most of the time they are all fine, but harboring the same fear: this time could be it.
People in this situation don’t really smile or make small talk; they are too immersed in their individual panic. They pretend to read magazines. I assume they are pretending because that’s what I’m doing. I pick up US Weekly and turn the pages, but while my eyes process the photos, the fearful chatter in my brain is so loud I’m sure everyone in the room can hear it: Look at that picture — Gwen Stefani’s kid is wearing goofy pants. Why would she do that to him? ... If I do have it, maybe I will have the type that only requires a lumpectomy ... Bronx — what kind of name is that? Celebrities should not be allowed to name their children: Bronx Wentz, Brooklyn Beckham. What’s next, Staten Island Gaga? ... So you lose your hair. I have a friend who looked better with her wig than with her real hair. You can get wigs that are amazing ... I wonder if Angelina really pays attention to those kids or it’s all a big photo op ... People go back to work with it. Look at Robin Roberts — she was on GMA the whole time she was getting chemo. And she looks great now ... That Heidi Montag—one more round of plastic surgery and she will look like Joan Rivers ... They say 80 percent of all the lumps they find are benign, so even if they find one, that is still a four-out-of-five chance that it will be nothing ... George Clooney with another waitress. What is it about men and waitresses? ... Even if it is something, almost everyone I know has lived — it’s a manageable disease now ... Sometimes it is—not all the time. A lot of women die ... I could die. Then I would never see Lucy and Taylor’s children ... What if they name one of them Bronx? If I were alive, I could stop that . .... If I live, I won’t care what they name him. I’ll just call him Onyx ... No one in my family has breast cancer. Family history is very important .... I think Christina Applegate looks better in her dress than Bethenny Frankel does in hers ... Wait, Christina Applegate had breast cancer, and look at her and Melissa Etheridge. They’re both doing fine. And Kate Jackson and Jaclyn Smith. It’s kind of weird when you think all three Charlie’s Angels got cancer and the ones who are alive were the ones with breast cancer. That’s a good sign ... I wonder if their set was near high-tension power lines or something . . Farrah died of cancer ... I mean, three people in one show got cancer and the show only had three people in it. You never saw Charlie — I wonder if he is alive ... I thought one in three got cancer. But that’s three in three . . .
This is the kind of crazy journey my mind takes while I’m sitting there waiting for my mammogram.
Blessedly, just about the time my head is about to explode, they call my name and I jump ten feet because despite the fact that all indicators point to the fact I know exactly where I am, the self-inflicted torture trip I’m on has sent me to this other world where reality, time, and space are totally abandoned and I am completely submerged in my most primal fears.
The waiting room is bad enough, but then you go into the antechamber, the small room where you take off your clothes (gown open to the front) and wait for your turn. At this point I’m way too nervous to even pretend to read. For some reason the women who actually take the images all have the same demeanor. I guess they are trained — look blank, say little, stay neutral, do not get emotionally involved with the patients. This makes it virtually impossible to get any information out of them. In the last fifteen years of getting this test (since I was thirty-five; Ed Liu always said it was better to be safe than sorry) I have tried every way I know to get them to respond, and nothing works. They are like the guards in front of Buckingham Palace, except they are middle-aged women, often from Eastern European countries, who spend their days squishing other women’s breasts and witnessing their panic.
While they are mashing my breasts between the plates (which, weirdly, has never bothered me as much as it bothers most people), I’m asking questions.
“Everything look okay?”
“I haven’t started yet.”
“See anything suspicious?”
“We have to take a picture before we can see anything.”
Not very comforting, but it has a certain logic. Then she takes the first picture.
“Now do you see anything wrong?”
“I only take the test. The doctor reads them.”
“Yeah, but you see hundreds of these a week, which translates into thousands a year.”
“Move an inch to the left.”
“But if you saw something out of the ordinary, you would know what that looked like.”
“We are going to do the right side now.”
“Like I know a bad script when I read one — the first two lines and I can tell you if it sucks or not — so my guess is you can just take one look and see if I have a lump, or a bump, or an inverted pimple, or a benign growth.”
“Go wait in the small room. We will let you know if we need more shots.”
And back you go to the antechamber. I always leave the door open a smidge hoping to overhear them talking to each other, but it’s usually about "American Idol" or something totally banal that has nothing to do with my mortality.
I think that second sit-down in the antechamber is the worst. Now, I go to someone who reads all the images herself and does it while you are there; at other places, you go home and wait for the phone to ring. I would rather devote the entire morning and know what’s up. But in my case that second wait is when they are figuring out if you do have something wrong and they need more tests to confirm it. It’s the guilty-until-proven innocent moment, and the part where I think my heart is going to beat right out of my chest.
Every now and then they come back and say, “The doctor would like some more images.” I would like some more images too, of me somewhere else, like in Starbucks with a latte, but back I go to the photo room, my feet dragging.
“You found something wrong?”
“The doctor wants to clarify.”
All you get back is the Beefeater stare.
Blessedly, that part is often just because I moved or the film registered a shadow. At the office I go to, the best antechamber outcome is, “You can put your clothes on.” When they say that, I pretty much know I am out of the woods.
There is nothing like the feeling when your report comes back clean. You bounce out of the office. It may sound overdramatic, and of course the elation is always qualified — it’s a temporary victory, a reprieve for another year, a momentary stay of execution — but I think that is how most of us feel.
There are four stages of our relationship with our breasts. There is the first stage, before they come in, when we wonder if we will ever get them. Then once they do put in an appearance, we spend years worrying that they don’t stack up, pardon the pun: that they are either too big, too small, too pointy, or too round, or that the nipples are too big, too brown, or (God forbid) have hairs coming out of them. By the time we get over worrying about whether they’re perfect, they are inevitably imperfect, as time, gravity, and hungry little mouths have taken their toll. This brings on the “Should I or shouldn’t I fix them?” question. Can I now have the breasts I always dreamed of? This was never a big issue for me, as I was busy thinking of the ass I always dreamed of. But for some women it is an important concern and this is the time when many women make a visit to the plastic surgeon for a boob job.
Regardless of how you handle the third stage, the fourth stage is the same for everyone. The last and final stage of a woman’s relationship to her mammary glands boils down to “Please, just let them be cancer-free. Let me get them through this lifetime intact and healthy. I don’t care if they hang down to my shoes, if they are covered with purple spots, or if they are flat like crepes. I just want them to be okay.” It’s amazing the different meanings “okay” takes on in relation to your breasts the older you get.
Breast cancer is clearly not going to go away, and while the incidence seems to be increasing, so are the life spans of people living with it. We have to do what we can to stay healthy, take care of our friends who are sometimes not so lucky, keep supporting the cause, buy the products whose proceeds end up being donated to research, and — despite the emotional turmoil it causes — show up for our annual mammogram and pray the odds are in our favor.
But — and it is a big but — there are a few things we can do to tip the odds in our favor.
One of my thirty-four doctors makes the claim that “up until fifty we get a hall pass from all the bad things we have done to our bodies, but come fifty the smoking, drinking, overeating, reckless eating, plus not exercising all catch up with you.” While we don’t have control over many things that happen to us as we age, we do have control over a few, including—and perhaps most importantly — how quickly and to what degree our body actually ages. Aging is very simply decay, unless you happen to be a steak or wine. The thing about decay is, we can’t stop it, but we can control it — we can retard it, we can put it off, we can hold it at bay.
You have to accept that no matter what you do, some things — your eyesight among them — will start to deteriorate. Unless you happen to be a superhero or a freak of nature, once you hit forty the print gets smaller, and by fifty it all blurs together. But thanks to the new Lasik surgeries and advances in cataract operations, once you get to a certain point, you can reverse the decline. My eighty-two-year-old father does not wear glasses anymore. He had the cataract surgery and they put those lenses in his eyes and when we go out to dinner I need glasses to read the menu and he doesn’t. In that case eighty is the new thirty and fifty is the new eighty. My eyes aren’t bad enough yet to warrant the operation, but I would totally do it.
The number one thing every one of us can do to help ourselves look younger, feel younger, look healthier, be healthier, and enjoy the benefits of everything from more stamina to less depression is to exercise and lose weight.
Obesity and overweight are the number one contributors to heart disease, diabetes, arthritis, and endless other chronic health problems. Thirty-three percent of America is obese; this is a fact.
People tend to make the same two excuses for not exercising, the first one being “I don’t have time.” To this I say, you don’t not have time. It’s very simple. Make the time. If you have to get up an hour earlier, do it. If you have to miss lunch, do it. I like to remind people that Barack Obama exercised every day while on the campaign trail, and now that he’s president, he still does. The busiest, most successful people I know make the time, and I think it makes them more productive. I would put money on that. The other excuse people give is, “It’s too expensive! I can’t afford to join a gym or take a class.” Nobody is telling you to hire a personal trainer or spend twenty bucks a day on yoga. If you have the money and it’s worth it to you, then do it, but one of the few things that is actually free in this world is exercise. What would it cost you to walk around the block? How about taking part in one of the many TV fitness programs?
You can spend $25 for a DVD and work out six days a week for a year at the cost of six and a half cents a day. If you can afford to buy this book, you can afford six and half cents a day to keep yourself in shape. And I’ll tell you what: that initial $25 is a hell of a lot cheaper than a doctor’s visit.
If you don’t like to work out alone, get a group of friends and make a daily date to walk for a few miles. If you work, do it late or get up an hour early. You will add years to your life, and they will be productive, healthy ones.
If you read this book and walk away with nothing else, I would want it to be that you change your life and exercise.
Chris Crowley, author of "Younger Next Year: A Guide to Living Like You Are Fifty Until You Are Eighty," points out that “every day your body makes a choice. It’s either going to get a little older (decay) or it will get a little stronger.” The only way it can get stronger is through exercise: strength training, endurance, and cardio work. You can, if not turn back the clock, at least make it stand still.
Let’s face it: one of the problems with most exercise is that it’s boring. And since the key to a successful exercise regimen is sticking with it, there are several crucial elements to consider when choosing your routine. The first one is finding something you actually enjoy. If you don’t enjoy it, eventually (perhaps as soon as tomorrow) you will stop doing it. For decades I was a serial exerciser; I always did something, but I was completely promiscuous. I would give up yoga for Pilates and Pilates for strength training, and when I lived in California I would swim six months a year. Then six years ago I found the perfect exercise for me (emphasis on “for me”), but I have been doing it six days a week for six years and I have never gotten bored. I have dropped three jean sizes, upped my metabolism, and never been stronger.
What I do is called Core Fusion. It’s a cross between Pilates, yoga, strength training, and a discipline called the Lotte Berk Method. In one hour you work out every part of your body, stretch, and strengthen, and for me it’s as much a part of my life as breathing. I cannot imagine living without it, and I don’t. Aside from the health benefits, working out is a great way to make friends. People in yoga classes become close; they go off on retreats together. It becomes not only a part of your life but a way of life. It becomes the way you choose to live. And as you get older, it is often all that stands between you and a walker.
The other major factor to consider in an ongoing fitness schedule is convenience. You may love that Thai boxing class across town, but unless your life is such that you can make it every day, it may have to be your weekend exercise treat. You have to find something that is either close to your home or office; if it’s not, I promise, you will find legitimate excuse after legitimate excuse not to go. And eventually it will fall into the category of too much trouble and you will eliminate it altogether. My gym is half a block from my house; there can be a blizzard and I can get there. I have no excuses. You may not have the luxury of having a gym or place you like so close, but you must find something that is close enough that it does not feel like a hassle to get there.
Third, you must do it at a time that fits into your daily life. And make it nonnegotiable. Whatever the time may be, that is your time to exercise; it can change from day to day depending on your agenda, but I find most of the people I know who work out daily do so at the same time.
Think about it: every day your body makes a choice as to whether it’s going to get a little stronger or a little weaker, and you have the power to decide which way it will go. In January, many people make New Year’s resolutions to take off that extra twenty pounds, cut back on the booze, and exercise. So January sees the highest number of people running to their neighborhood gym and signing up. Everyone is turning over the proverbial new leaf. But do you know how many people actually follow through on their new plans? Very, very few. Forty percent of those who join health clubs stop going soon afterward, and 50 percent stop going within the first six months. Of those who actually continue, they go on an average of eighty-nine times a year. So while people may be signing up, for the most part they are not turning up. Joining a gym and going to one are two entirely different acts. One is loaded with good intentions, the other with vital results.
I am very hard-ass about this because I know, and all the research will tell you, that exercise is the only thing that works. Cardiologists will tell you, GPs will tell you, shrinks will tell you, anyone who knows anything about or cares about health, both physical and mental, will tell you it’s one of the few defenses you actually have against looking and feeling like your grandparents’ fifty, sixty, or seventy, and it gives you a chance to get to be an energetic eighty.
Exercise will keep your muscles from atrophying, your energy up, and your moods stable; it will decrease your body fat, up your metabolism, and strengthen your bones so you don’t become one of those broken-hip stats. (My grandmother had genes on her side; she really shouldn’t have lived as long as she did considering the care — or lack of care — she took of herself, but it was a hip fracture that ultimately brought her down. It’s not that the fracture itself actually kills you, but it lays you out and makes way for a whole host of other things to invade your weakened body.)
I could write down all the things that can go wrong with us once we hit fifty, but our collective time is better spent addressing the ways we can feel better. The other no-brainer in this— and it goes with the exercise—is of course what and how we eat.
At this stage, especially for women, our metabolism slows down, even when we are exercising regularly. It’s why all of a sudden women at around fifty have that little tool belt of flab around their middles. But besides the looks issue, which is not nothing, the old adage “You are what you eat” is, while important throughout your life, never more crucial than when you hit this stage of life. The thing about good eating habits is that habits are exactly that: the way you eat forever.
I do not believe diets work in the long run — and trust me, I have been on every one known to man. I spent twenty years of my life a good fifteen to twenty pounds overweight. I can still recite from memory the whole week of the Scarsdale Diet. I have done Atkins, South Beach, every fast. You name it — if it promised to drop weight quickly, I tried it. And sure, they all work: you lose ten pounds fast, then you go out and eat a tuna fish sandwich and six come back on before you’ve finished it.
When Bryant Gumbel was still on TODAY and his weight was fluctuating like the price of gold, he decided to do a survey of what diets worked the best and cost the least per pound lost. The only one that proved to have long-lasting results was Weight Watchers — and that is because it teaches you not how to lose a fast ten pounds but how to change your eating habits for life.
If you live in this country, you know how to eat. It is very simple. Even Subway and McDonald’s are now forced to tell you the healthy choices. No one has an excuse. It’s not like the fifties and sixties, when everybody smoked without knowing the harm it was causing. Starting in 1965, all cigarette packs had warnings on them, though they were not as ominous as they are now and people could still smoke everywhere including the doctor’s office. Doctors smoked in front of you. Athletes advertised them. Think about it; it would be like Barry Bonds being the spokesperson for steroids today.
The same is true with food. When I was growing up, a few people—the ones my mother sought out, the Gayelord Hausers and Jack LaLannes — knew what could hurt you, but not many others cared or believed it anyway. But today we have nutrition information on every label in the supermarket and a proliferation of diet books, health books, healthy food books, and study after study about what is good and what is bad. It seems like every week they find a new berry lurking in the rain forest that is the antioxidant of all time.
It comes down to common sense: as intelligent Americans with access to the media, which reports on every medical and dietary advancement (sometimes even before they are discovered), we know what to do. I think there is something almost condescending in telling people what to eat and what not to eat. My eight-year-old knows. We all know. At this point it becomes like exercise — it’s in your hands. We choose to do it, or not.
Everyone knows that french fries are bad and apples are good. Too much alcohol is bad; a little is okay. Meat every now and then is fine; a sixteen-ounce porterhouse every night is sure to do you in eventually. Sugar sucks no matter which way you cut it: it’s bad for your weight, it’s bad for your body, it’s bad for your moods. It is a bad, bad substance. It’s addictive and nasty, and I don’t think it’s a coincidence that it looks like cocaine. It’s the cocaine of food. Soft drinks — stay away from all of them. Juices — the same. Sugar is the devil.
Diabetes kills more women than breast cancer. The numbers are staggering: between diagnosed cases, undiagnosed cases, and prediabetes, 80.6 million have it in some form. That is almost a third of the entire population. Twenty-three percent of those over sixty have it. But with lifestyle intervention you can reduce your risk by 58 percent over three years.
In labs they grow sugar in tumors. A friend of mine who has been battling cancer for years told me that they tell you not to eat sugar in the two days before a PET scan, as it lights up the same way as the cancer cells. Does that tell you anything? The old notion that sugar was bad for your teeth was just the beginning; it’s bad for everything. Look at kids who eat it and start getting hyperactive and uncontrollable. Well, it does the same for you, only you crash and get depressed, especially if you are menopausal and already suffering mood swings. And the thing about it is, once you take it out of your diet, you really don’t miss it. I’m not saying you can never eat another cookie or dish of ice cream or whatever your favorite may be, but make it an occasional treat, something you indulge in every now and then. It’s all about balance.
It’s also about getting yourself checked out. Does everyone over fifty need thirty-five doctors? Probably not. Does everyone over fifty need to pay more attention to their bodies through regular testing for some basic things? Absolutely.
One of the biggest is to get your heart checked. While we are obsessed with our breasts and most of us get mammograms, women for the most part do not get their hearts checked until something goes wrong. It smacks a bit of the barn door, if you ask me. If you are over fifty, you should get your heart checked at least once, get a baseline, and figure out the rest of your plan from there. The point was really driven home to me earlier this year when I went in to visit my cardiologist.
Being in my early fifties and with zero risk factors, I often have people say to me, “Why are you going to a cardiologist?” Number one, I believe in getting checked. Number two, in this case I was going in for some elective surgery and needed a clean EKG to get clearance. I thought it would be a no-brainer; it turned into anything but, though I learned a lot.
I have a slightly irregular heartbeat, but no one ever worried much about it. Wouldn’t you know — the day I went in for my EKG, my beats were all over the place. They looked like a three-year-old’s drawing of the Alps. It didn’t seem to worry the cardiologist that much, but I have this terrible habit of asking doctors so many questions that even if they think I am probably fine, after my ten-minute inquisition I convince them otherwise. So after I presented him with any number of possible disasters, he decided we had better get to the bottom of it and I should wear a heart monitor. Before I knew it I was down the street at the arrhythmia consultant (also known as an electrophysiologist), being hooked up to a twenty-four-hour heart monitor.
So around I went with my heart monitor, wondering why if there really was nothing wrong with me, I looked liked someone hooked up to life support. Now, if you want to feel about eighty years old and the least sexy person alive, look at yourself with a heart monitor on; it’s really pathetic. I hid under sweaters and robes for the twenty-four hours I wore it, hoping my kids wouldn’t see it — and, frankly, trying to avoid looking at it myself. But I managed to exercise in it and eventually got up the courage to start talking about it, and the amazing thing is once I started talking about it, it turns out all sorts of people had worn them, were about to wear them, or were thinking of wearing one. I learned they are actually a good idea.
During the twenty-four hours you are supposed to just go about your life; the doctor actually wants you to exercise, have sex, and do whatever you do that gets your heart rate up. What got my heart rate up was wearing the freaking monitor; it made me a nervous wreck. And in terms of sex, please — I can’t imagine how anyone would pull that off. The nanosecond the twenty-four hours were up I ripped that sucker off so fast, I’m amazed I didn’t take a layer of skin with it.
Two days later I showed up at the office of my new electrophysiologist for my diagnosis. “Your irregular beats don’t worry me,” she said, “because they come from the lower chamber. If it came from the upper chamber, it would be something else, something we might have to really investigate, but looking at all your other stats ... Don’t drink too much coffee, and come see me this time next year.”
But of course I couldn’t leave well enough alone.
“You’re sure it’s not my arteries?” She had not mentioned my arteries.
Well, that was all she had to hear. I’m sure what I was unconsciously saying and she was picking up on was, What if you have left a stone unturned, and what if that stone leads to my having a heart attack?
She said, “You’re right, and your heart could be enlarged too.”
Now, she hadn’t said that before, and the cardiologist had not only given me an EKG but had done an echocardiogram, which shows if your heart is enlarged. I reminded the electrophysiologist that the cardiologist had checked my heart and said it was normal size. “Well, not the back,” she said. “He can’t see the back and right side, only the front and left.”
Great — my third heart test in as many days, and they still knew nothing. Talk about irregular beats! My heart sounded like Ringo Starr was practicing on it.
So she said, “You must go get an MRI.”
An MRI? How the hell had we gotten from there to here?
“It’s the only way to really find out,” she said.
So now I had to go see another guy to get an MRI. Terrific. The day I went was snowy, my appointment was at the end of the day and they were running late, and it was my daughter’s birthday. I kept thinking, What if they find I have an enlarged heart and have six months to live? How will I ever sing “Happy Birthday” to her? It was not the eighth or the sixteenth, and so I had no way of hedging my bets; I was left in the hands of fate.
At the MRI place I was the last one of the day. I answered another nine-thousand-question survey. I checked off for the seventeenth time that week that no, I do not have epilepsy, seizures, or prostate cancer; I’m not pregnant, nursing, or suffering from kidney disease. I’m just a high-strung Jew! I actually think they should add that to those questionnaires. In-denial WASP? High-strung Jew? Accepting Buddhist? I always check off the same things, “asthma” and “anxiety,” which I guess is as close to “high-strung Jew” as they can get without sounding anti-Semitic.
MRIs are not a day at the beach. I don’t mind them as much as many people do; there was a period when I spent a lot of time in sensory deprivation tanks, and MRI machines kind of remind me of a scary version of those. But if you had your choice between a mani-pedi and an MRI, well ...
This one required prep, as I would have two IVs so they could look at the arteries and the heart at the same time. Cool — one last test, kill two birds with one stone. Deep breaths. I can’t breathe. My heart is racing — oh, right, that’s why I’m here.
I got all geared up and climbed on the MRI machine. In came the MRI guy; it turned out he was a cardiac radiologist, he had gone to med school (I always thought they were like chiropractors). But he took one look at me and asked me about my asthma. I have normal asthma, I told him. What is normal? Mine.
“Well, in that case we can’t do the test to see your arteries,” he said, “as the solution we inject into your veins can have a bad effect on asthmatics. But let me go call the electrophysiologist to check.”
So off goes the cardiac radiologist to powwow with the electrophysiologist, and I was thinking maybe they should have chatted before I arrived. But he was just being vigilant, and I didn’t want to get my heart rate up. So I lay there listening to some machine that went swoosh, swoosh, swoosh, but if you listened really carefully, it sounded like it was saying man down, man down, man down — not a reassuring mantra under the circumstances.
He returned to say that the verdict was that he could do only the one test; they could not look at my arteries.
“But that’s what I’m here for.”
“Well, no, you are also here for a possible enlarged heart.”
Couldn’t everyone maybe stop bringing that up?
So into the MRI I went. Forty minutes of breathe in, breath out, hold your breath, and you think it’s half over but find out it’s only a third over. Then I started doing fractions, and at one point I pretended it was the sensory deprivation tank, but just as I relaxed it started making noises like I was on the inside of a Cuisinart. I started envisioning what I would look like if they had to crack open my chest, or who might donate a heart if I needed one.
Eventually they rolled me out, took out the needles, and told me to go get dressed so I could chat with the radiologist. On my way out I saw him sitting in the hallway looking at three monitors with my heart on them. I instantly asked him if I would live; he told me, “Yes, at least for the moment,” and then told me to go get dressed. For the moment? He must have trained those girls over at the breast radiologist’s.
After I was dressed, he patiently explained to me all the workings of my heart. It was kind of cool; I got to see it beating in a big photo. The upshot was that my heart is fine. It is a normal size, perfect. Great, I thought — I could get clearance for my procedure.
“Well, not so fast. The electrophysiologist is not going to give you clearance until she sees your arteries.”
“Why can’t you give me clearance? You’re looking at it.”
“I didn’t order the tests.”
When had the electrophysiologist become the head decision maker for my team? She was just the heart monitor person. This guy seemed totally competent, plus he had a full-blown picture of my heart in front of him. She only had some wonky inconclusive papers that had required her to send me to him. He was looking at the real deal.
“She ordered the test, she is in charge of the EKGs, and she has to give you the okay, which means we have to see your arteries.”
“Do you think my arteries are okay?” I pleaded.
“I won’t know until I see them. I imagine they are. But you know, I had a guy in here with perfect cholesterol, perfect blood pressure, and he was ninety percent blocked.”
I hate it when doctors tell those stories, and they all have one: patient perfect who turns out to be patient almost dead.
“You can have a stress test,” he said.
I didn’t want a stress test. I knew I would fail a stress test. It’s like taking a driving test again. It’s one of the reasons I keep my California driver’s license, so I don’t have to take the driving test again. I do not want to take tests I am bound to fail.
“If you don’t want to take the stress test, we happen to have the gold-standard machine that will show you every artery and all the plaque buildup, and if it’s okay, you won’t have to take another one for years.”
What kind of test was it? A CAT scan.
Swell — from the MRI to the CAT scan. But by then I was so convinced that I had heart disease, I decided I had better find out how bad it really was. “Okay, I’ll do a CAT scan, but I need it now.”
“Well, I don’t have any technicians left.” I realized it was almost seven and the office was closing.
“Tomorrow, then,” I barked. “I have to have it tomorrow.”
“We’ll try to work you in.”
I think this guy thought I was sort of demanding and it was better to get me in and out as quickly as possible.
At least I could go off to have dinner with the family knowing my heart was not enlarged and all I had left was to verify that my arteries were clear. Which at that point felt like saying, “All we have left is the Taliban to deal with.”
This CAT scan was a breeze compared to the MRI. It was six minutes, another IV, but in and out. The upshot was I had zero plaque buildup. The “arteries of an eighteen-year-old,” they told me. Now, this may not sound like much to you, but to put it in perspective, when I took the test results to the cardiologist's office, they said they had actually never seen a zero score in all the years they had been practicing. I had the lowest plaque buildup of anyone they had seen in over twenty years. This happens to be genetic; I cannot take credit for it, though I wish I could tell you there was something you could do to get that result.
So these tests not only alert you to when something could be wrong, like the guy with the perfect everything who was in fact a time bomb, but allow you and your doctors to know where you stand now, how you should move forward, and what if any medicines you should/could be taking to help prevent a nasty situation from arising in the future. And in my case, I now know that when I get myself all worked up and get the pain down my arm, get short of breath, and work myself into a tizzy, I’m not having a heart attack, I’m just doing what I do best — driving myself crazy.
From "Between a Rock and a Hot Place" by Tracey Jackson. Copyright © 2011. Reprinted by permission of HarperCollins.